Category: Nevin Manimala

Aktuelle Urol. 2023 Jun 20. doi: 10.1055/a-2090-5199. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, 959 men in Germany and 67 in Austria are diagnosed with penile cancer each year, with an increase of approximately 20% in the last decade [RKI 2021, Statcube.at 2023]. Despite the rising incidence, the number of cases per hospital remains low. The median annual number of penile cancer cases at university hospitals in the DACH region was 7 patients (IQR 5-10) in 2017 [E-PROPS group 2021]. The compromised institutional expertise due to low case numbers is compounded with inadequate adherence to penile cancer guidelines, as shown in several studies. The centralization, which is rigorously implemented in countries such as the UK, enabled a significant increase in organ-preserving primary tumor surgery and stage-adapted lymphadenectomies, as well as improved patient survival in cases of penile cancer, resulting in a claim for a similar centralization in Germany and Austria. The aim of this study was to determine the current effects of case volume on penile cancer related treatment options at university hospitals in Germany and Austria.

MATERIALS AND METHODS: In January 2023, a survey was sent to the heads of 48 urological university hospitals in Germany and Austria, including questions regarding case volume in 2021 (total number of inpatient and penile cancer cases), treatment options for primary tumors and inguinal lymphadenectomy (ILAE), the availability of a designated penile cancer surgeon, and the professional responsibility for systemic therapies in penile cancer. Correlations and differences related to case volume were statistically analyzed without adjustments.

RESULTS: The response rate was 75% (n=36/48). In total, 626 penile cancer patients were treated at the 36 responding university hospitals in 2021, representing approximately 60% of the expected incidence in Germany and Austria. The annual median total number of cases was 2807 (IQR 1937-3653), and for penile cancer, it was 13 (IQR 9-26). There was no significant correlation between the total inpatient and penile cancer caseloads (p=0.34). The number of organ-preserving therapy procedures for the primary tumor, the availability of modern ILAE procedures, the presence of a designated penile cancer surgeon, and the responsibility for systemic therapies were not significantly influenced by the total inpatient or penile cancer case volume of the treating hospitals, regardless of whether the case volumes were dichotomized at the median or upper quartile. No significant differences between Germany and Austria were observed.

CONCLUSION: Despite a significant increase in the annual number of penile cancer cases at university hospitals in Germany and Austria compared to 2017, we found no case volume-related effects on structural quality with respect to penile cancer therapy. In the light of the proven benefits of centralization, we interpret this result as an argument for the necessity of establishing nationally organized penile cancer centers with even higher case volumes compared to the status quo, in light of the proven benefits of centralization.

PMID:37339667 | DOI:10.1055/a-2090-5199

Rev Bras Ginecol Obstet. 2023 May;45(5):242-252. doi: 10.1055/s-0043-1770126. Epub 2023 Jun 20.

ABSTRACT

OBJECTIVE: Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity.

METHODS: This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%).

RESULTS: The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033).

CONCLUSION: Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

PMID:37339643 | DOI:10.1055/s-0043-1770126

J Neural Eng. 2023 Jun 20. doi: 10.1088/1741-2552/acdffd. Online ahead of print.

ABSTRACT

Recent event-based analyses of transient, intermittent burst-like activities in the beta and gamma frequency ranges have characterized the oscillatory bursts as a neural signature that bridges dynamic neural states to cognition and behavior. While a precise detection of burst events is crucial for inferring their relations to behaviors, large variations of the background noise in the signal poses challenges for precisely identifying their onsets. Here, we examined several classic burst detection algorithms and their robustness to noise by comparing their ability to extract bursts under different conditions of signal-to-noise ratio and event duration using synthesized signals containing bursts of multiple frequencies. Our findings revealed that the detection of bursts is heavily influenced by event duration, while the precise identification of burst onsets is relatively more susceptible to the noise level. Given that burst properties in real signals are typically unknown in advance, we proposed a selection rule that utilizes the empirical cumulative distribution function and its associated area under the curve as potential criteria for determining the most suitable algorithm for a given dataset. To validate our rule, we applied the selected algorithm to theta, beta, and gamma activities in the basolateral amygdala of male mice during exposure to a spider robot-induced threat. The chosen method exhibited high detection and temporal accuracy, although statistical significance was not consistently observed between the different algorithms across frequency bands. Notably, the algorithm selected by human visual screenings did not always align with the algorithm recommended by our selection rule, indicating a mismatch between human priors and mathematical assumptions embedded in the algorithms. Consequently, our proposed rule offers a potential solution for algorithm selection in burst detection; however, its implementation also exposes the limitations of these algorithms, highlighting their variable performance depending on the dataset and cautioning against relying solely on heuristic-based approaches.

PMID:37339619 | DOI:10.1088/1741-2552/acdffd

Netw Neurosci. 2023 Jan 1;7(1):299-321. doi: 10.1162/netn_a_00284. eCollection 2023.

ABSTRACT

Executive functioning (EF) is a higher order cognitive process that is thought to depend on a network organization facilitating integration across subnetworks, in the context of which the central role of the fronto-parietal network (FPN) has been described across imaging and neurophysiological modalities. However, the potentially complementary unimodal information on the relevance of the FPN for EF has not yet been integrated. We employ a multilayer framework to allow for integration of different modalities into one ‘network of networks.’ We used diffusion MRI, resting-state functional MRI, MEG, and neuropsychological data obtained from 33 healthy adults to construct modality-specific single-layer networks as well as a single multilayer network per participant. We computed single-layer and multilayer eigenvector centrality of the FPN as a measure of integration in this network and examined their associations with EF. We found that higher multilayer FPN centrality, but not single-layer FPN centrality, was related to better EF. We did not find a statistically significant change in explained variance in EF when using the multilayer approach as compared to the single-layer measures. Overall, our results show the importance of FPN integration for EF and underline the promise of the multilayer framework toward better understanding cognitive functioning.

PMID:37339322 | PMC:PMC10275212 | DOI:10.1162/netn_a_00284

Dis Colon Rectum. 2023 Jun 20. doi: 10.1097/DCR.0000000000002686. Online ahead of print.

ABSTRACT

BACKGROUND: The association of micropapillary pattern with oncologic outcomes has not been fully studied in patients with colon cancer.

OBJECTIVE: We evaluated the prognostic value of micropapillary pattern, especially for patients with stage II colon cancer.

DESIGN: A retrospective comparative cohort study using propensity score matching.

SETTING: This study was conducted at a single tertiary center.

PATIENTS: The patients with primary colon cancer undergoing curative resection from October 2013 to December 2017 were enrolled. The patients were grouped into micropapillary pattern (+) or micropapillary pattern (-).

MAIN OUTCOME MEASUREMENTS: Disease-free survival and overall survival.

RESULTS: Of the eligible 2,192 patients, 334 (15.2%) were micropapillary pattern (+). After 1:2 propensity score matching, 668 patients with micropapillary pattern (-) were selected. Micropapillary pattern (+) group showed significantly worse 3-year disease-free survival (77.6% vs. 85.1%, p = 0.007). Three-year overall survival of micropapillary pattern-positive and micropapillary pattern-negative did not show a statistically significant difference (88.9% vs. 90.4%, p = 0.480). In multivariable analysis, micropapillary pattern -positive was an independent risk factor for poor disease-free survival (hazard ratio 1.547, p = 0.008). In the subgroup analysis for 828 patients with stage II disease, 3-year disease-free survival deteriorated significantly in micropapillary pattern (+) patients (82.6% vs. 93.0, p < 0.001). Three-year overall survival was 90.1% and 93.9% in micropapillary pattern (+) and micropapillary pattern (-), respectively (p = 0.082). In the multivariable analysis for patients with stage II disease, micropapillary pattern (+) was an independent risk factor for poor disease-free survival (hazard ratio 2.003, p = 0.031).

LIMITATIONS: Selection bias due to the retrospective nature of the study.

CONCLUSIONS: Micropapillary pattern (+) may serve as an independent prognostic factor for colon cancer, especially for patients with stage II disease.

PMID:37339285 | DOI:10.1097/DCR.0000000000002686

J Clin Endocrinol Metab. 2023 Jun 20:dgad371. doi: 10.1210/clinem/dgad371. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid function has been associated with metabolic syndrome (MetS) in a number of observational studies. In spite of that, the direction of effects and the exact causal mechanism of this relationship is still unknown.

METHODS: We performed a two-sample bidirectional Mendelian randomization (MR) study using summary statistics from the most comprehensive genome-wide association studies (GWAS) of thyroid-stimulating hormone (TSH, n = 119,715), free thyroxine (fT4, n = 49,269), MetS (n = 291,107), as well as components of MetS: waist circumference (n = 462,166), fasting blood glucose (n = 281,416), hypertension (n = 463,010), triglycerides (TG, n = 441,016) and high-density lipoprotein cholesterol (HDL-C, n = 403,943). We chose the multiplicative random-effects inverse variance weighted (IVW) method as the main analysis. Sensitivity analysis included weighted median and mode analysis, as well as MR-Egger and Causal Analysis Using Summary Effect estimates (CAUSE).

RESULTS: Our results suggest that higher fT4 levels lower the risk of developing MetS (OR = 0.96, P = 0.037). Genetically predicted fT4 was also positively associated with HDL-C (β=0.02, P = 0.008), while genetically predicted TSH was positively associated with TG (β=0.01, P = 0.044). These effects were consistent across different MR analyses and confirmed with the CAUSE analysis. In the reverse direction MR analysis, genetically predicted HDL-C was negatively associated with TSH (β=-0.03, P = 0.046) in the main IVW analysis.

CONCLUSIONS: Our study suggests that variations in normal-range thyroid function are causally associated with the diagnosis of MetS and with lipid profile, while in the reverse direction, HDL-C has a plausible causal effect on reference-range TSH levels.

PMID:37339283 | DOI:10.1210/clinem/dgad371

Proc Natl Acad Sci U S A. 2023 Jul 4;120(27):e2303168120. doi: 10.1073/pnas.2303168120. Epub 2023 Jun 20.

ABSTRACT

We briefly review the majorization-minimization (MM) principle and elaborate on the closely related notion of proximal distance algorithms, a generic approach for solving constrained optimization problems via quadratic penalties. We illustrate how the MM and proximal distance principles apply to a variety of problems from statistics, finance, and nonlinear optimization. Drawing from our selected examples, we also sketch a few ideas pertinent to the acceleration of MM algorithms: a) structuring updates around efficient matrix decompositions, b) path following in proximal distance iteration, and c) cubic majorization and its connections to trust region methods. These ideas are put to the test on several numerical examples, but for the sake of brevity, we omit detailed comparisons to competing methods. The current article, which is a mix of review and current contributions, celebrates the MM principle as a powerful framework for designing optimization algorithms and reinterpreting existing ones.

PMID:37339185 | DOI:10.1073/pnas.2303168120

Can Assoc Radiol J. 2023 Jun 20:8465371231180815. doi: 10.1177/08465371231180815. Online ahead of print.

ABSTRACT

Background and Purpose: Evidence has emerged for an association between degenerative disc disease (DDD) and multiple sclerosis (MS). The purpose of the current study is to determine the presence and extent of cervical DDD in young patients (age <35) with MS, an age cohort that is less well studied for these changes. Methods: Retrospective chart review of consecutive patients aged <35 referred from the local MS clinic who were MRI scanned between May 2005 and November 2014. 80 patients (51 female and 29 male) with MS of any type ranging between 16 and 32 years of age (average 26) were included. Images were reviewed by 3 raters and assessed for presence and extent of DDD, as well as cord signal abnormalities. Interrater agreement was assessed using Kendall’s W and Fleiss’ Kappa statistics. Results: Substantial to very good interrater agreement was observed using our novel DDD grading scale. At least some degree of DDD was found in over 91% of patients. The majority scored mild (grade 1, 30-49%) to moderate (grade 2, 39-51%) degenerative changes. Cord signal abnormality was seen in 56-63%. Cord signal abnormality, when present, occurred exclusively at degenerative disc levels in only 10-15%, significantly lower than other distributions (P < .001 for all pairwise comparisons). Conclusions: MS patients demonstrate unexpected cervical DDD even at a young age. Future study is warranted to investigate the underlying etiology, such as altered biomechanics. Furthermore, cord lesions were found to occur independently of DDD.

PMID:37339165 | DOI:10.1177/08465371231180815

JMIR Cardio. 2023 Jun 20;7:e45352. doi: 10.2196/45352.

ABSTRACT

BACKGROUND: The prediction of posttransplant health outcomes for pediatric heart transplantation is critical for risk stratification and high-quality posttransplant care.

OBJECTIVE: The purpose of this study was to examine the use of machine learning (ML) models to predict rejection and mortality for pediatric heart transplant recipients.

METHODS: Various ML models were used to predict rejection and mortality at 1, 3, and 5 years after transplantation in pediatric heart transplant recipients using United Network for Organ Sharing data from 1987 to 2019. The variables used for predicting posttransplant outcomes included donor and recipient as well as medical and social factors. We evaluated 7 ML models-extreme gradient boosting (XGBoost), logistic regression, support vector machine, random forest (RF), stochastic gradient descent, multilayer perceptron, and adaptive boosting (AdaBoost)-as well as a deep learning model with 2 hidden layers with 100 neurons and a rectified linear unit (ReLU) activation function followed by batch normalization for each and a classification head with a softmax activation function. We used 10-fold cross-validation to evaluate model performance. Shapley additive explanations (SHAP) values were calculated to estimate the importance of each variable for prediction.

RESULTS: RF and AdaBoost models were the best-performing algorithms for different prediction windows across outcomes. RF outperformed other ML algorithms in predicting 5 of the 6 outcomes (area under the receiver operating characteristic curve [AUROC] 0.664 and 0.706 for 1-year and 3-year rejection, respectively, and AUROC 0.697, 0.758, and 0.763 for 1-year, 3-year, and 5-year mortality, respectively). AdaBoost achieved the best performance for prediction of 5-year rejection (AUROC 0.705).

CONCLUSIONS: This study demonstrates the comparative utility of ML approaches for modeling posttransplant health outcomes using registry data. ML approaches can identify unique risk factors and their complex relationship with outcomes, thereby identifying patients considered to be at risk and informing the transplant community about the potential of these innovative approaches to improve pediatric care after heart transplantation. Future studies are required to translate the information derived from prediction models to optimize counseling, clinical care, and decision-making within pediatric organ transplant centers.

PMID:37338974 | DOI:10.2196/45352